Linezolid (Burns — Vancomycin-Resistant/Refractory MRSA)

How it works

It inhibits bacterial protein synthesis by binding the 23S ribosomal RNA of the 50S subunit and preventing formation of the initiation complex, giving activity against Gram-positive organisms including MRSA and VRE.

Prescribing in practice

• It is a reversible monoamine oxidase inhibitor and can precipitate serotonin syndrome with serotonergic drugs and hypertensive reactions with sympathomimetics or tyramine-rich foods — review medications carefully before use.
• Prolonged courses cause myelosuppression (especially thrombocytopenia) and optic and peripheral neuropathy, so limit duration and avoid extended treatment.
• Reserve for confirmed or strongly suspected resistant Gram-positive infection to preserve activity and limit toxicity.

Monitoring

Monitor full blood count regularly during therapy and review courses promptly, with assessment of visual symptoms if treatment is prolonged.

Counselling the patient

• Avoid large amounts of tyramine-rich foods such as mature cheese, and tell the team about all other medicines including antidepressants.
• Report any visual changes, persistent numbness or tingling, or unusual bruising or bleeding.

Evidence & guidelines

MHRA and the SPC highlight linezolid-associated blood disorders and optic neuropathy with prolonged use, and its monoamine-oxidase-inhibitor interactions.